Ready to take your IT skills to the healthcare industry? This concise book provides a candid assessment of the US healthcare system as it ramps up its use of electronic health records (EHRs) and other forms of IT to comply with the government’s Meaningful Use requirements. It’s a tremendous opportunity for tens of thousands of IT professionals, but it’s also a huge challenge: the program requires a complete makeover of archaic records systems, workflows, and other practices now in place.

This book points out how hospitals and doctors’ offices differ from other organizations that use IT, and explains what’s necessary to bridge the gap between clinicians and IT staff.

Get an overview of EHRs and the differences among medical settings

Learn the variety of ways institutions deal with patients and medical staff, and how workflows vary

Discover healthcare’s dependence on paper records, and the problems involved in migrating them to digital documents

Understand how providers charge for care, and how they get paid

Explore how patients can use EHRs to participate in their own care

Examine healthcare’s most pressing problem—avoidable errors—and how EHRs can both help and exacerbate it

Fred Trotter

Fred Trotter is a hacktivist. He works for social change by coding and promoting Open Source Health Software. In recognition of his role within the Open Source Health Informatics community, Trotter was the only Open Source representative invited by congress to testify on the definition of ‘meaningful use’ for the federal health care incentives law (Meaningful Use). Trotter also represented the Open Source EHR community in negotiations with CCHIT, the leading EHR certification body.

Trotter is the original author of FreeB, the worlds first GPL medical billing engine. In 2004 Fred Trotter received the LinuxMedNews achievement award for work on FreeB. Fred Trotter was an editor for the Open Source EHR review project with the American Medical Informatics Association (AMIA), Open Source Working Group (oswg). Fred is a member of WorldVistA and is the programmer behind Astronaut Shuttle which is the first cloud-based VA VistA offering.

Fred Trotter is a recognized expert in Free and Open Source medical software and security systems. He has spoken on those subjects at the SCALE DOHCS conference, OSCON, LinuxWorld, DefCon and is the MC for the Open Source Health Conference. He has been quoted in multiple articles on Health Information Technology in several print and online journals, including WIRED, ZSnet, Government Health IT, Modern Healthcare, Linux Journal, Free Software Magazine, NPR and LinuxMedNews. Trotter has a B.S in Computer Science, a B.A in psychology and a B.A in philosophy from Trinity University. Trotter minored in Business Administration, Cognitive Science, and Management Information Systems. Before working directly on health software, Trotter passed the CISSP certification and consulted for VeriSign on HIPAA security for major hospitals and health institutions. Trotter was originally trained on information security at the Air Force Information Warfare Center.

David Uhlman

David is CEO of ClearHealth Inc. which created and supports ClearHealth, the first and only open source Meaningful Use certified Comprehensive Ambulatory EHR. Coming from a background of supply chain systems and big business ERP for companies including DEC, Micro Systems, Motorola, and EDS, David entered health care in 2001 as CTO for the OpenEHR project. One of the first companies to try commercializing open source healthcare systems, OpenEHR met face first with thedifficult realities of bringing proven mainstream technologies into the complicated and sometimes nonsensical world of health care. In 2003 David became CEO of ClearHealth and created theClearHealth system based on VistA that was originally developed by the Veterans Health Administration.

ClearHealth’s software is open source (GPL) and powers more than 1,000 sites from small offices to mega-institutions servicing millions of patients per year. As CEO of ClearHealth Inc. David alsooversees outsourced management and operations consulting of several general practice groups and in 2013 will begin operating it’s own general practice facilities.

A frequent speaker and writer David has presented and OSCON, TEPR, LinuxWorld, SCALE, OSHC, and others. You can see his work online in Modern Health Care, Wired, Linux Journal, and on his blog: Health 365.

The authors, as noted in the book, are experienced people with regard to healthcare-related information technology. Mr. Trotter in particular has been an advocate of VistA and its offspring for quite some time. I, myself, do software development using the Java language as a base, and have done consulting work in addition to healthcare providers, i.e. physicians practices, regarding selection and implementation of electronic medical records systems. I also recommended to Craig Barrett, the retired chairman of Intel, who was involved in the Dossia project discussed in the book, to find an alternative, including consideration of Indivo, to the approach taken at the time for development of Dossia, in which Intel, as company, was a participant.

Messrs. Trotter and Uhlman cover all the key topics in their book and do an excellent job on each one.

Personally, I am strong advocate of so-called single-payer/single-insurer systems for financing medical services. Such a financing scheme is in effect Medicare for all. Intelligent application of computer technology and networking are important parts of a reasonably well-functioning healthcare system. Their implementation has merit no matter what the financing or medical delivery system is in force.

I'm only halfway through this book, but just decided I have to buy one for each of my staff, stat. This is the first HIT book I've read any of that struck me as so incredibly direct, down-to-earth, and comprehensive. Kudos.

The PROS are that it's obviously written by a cutting-edge industry expert, with humour and insight, and deep consideration for the legal and ethical issues. It's detailed enough for a reference book, and I hope, given the pace with which the industry evolves, there will be 2nd and 3rd editions issued quite rapidly. At the same time, there is a light conversational style, not quite in the nature of a manifesto, but which makes it very clear that health IT is an uphill struggle, an insight gained by the authors through bitter experience. It's also one of those rare books which is aware that it is trying to bridge two disciplines which historically haven't had much rewarding contact (healthcare and IT).

Which leads me to the CONS. This book was obviously published in a hurry. It lacks basic proofreading, something which annoys me enormously from lesser publishing houses, but which I certainly do not expect from O'Reilly. It also leads to confidence issues; if basic errors such as "... institutions could getting [sic] about $50,000 per doctor ..." abound, what other errors are there that are less visible but are perhaps more pernicious? And this is on page 8. I found at least one minor punctuation mistake before that, too (a misplaced comma).

To be fair, I've not read it from cover to cover; I think I will, because I find the discursive style engaging, and the ethical and legal issues are rarely so prominent as they are in health IT. But I do hope that before the second edition goes out, a different proofreader to the original one gets to cast an eye over it.

I am in the target audience as well as having worked on getting VistA to the point of passing "Meaningful Use". The book lays out the issues pretty well, but it is not finished. The next round of "Meaningful Use" hurtles are coming. There are additional functionality to be invoked by the certifying organizations. If you are just getting started in "Meaningful Use" this is the book to start with.

I am in the target audience for this book, a programmer with a background in consumer electronics who now works for a company that sells medical billing, an EHR, and other health care IT. Trotter and Uhlman provide a lot of context and filled in a lot of gaps in my understanding of the practice and business of medicine, and in the specific IT issues in the medical domain. I appreciated the range of levels of abstraction, from systemic problems in U.S. health care to the nitty gritty of message data formats, all informed by authors' extensive experience. I also noted the advice along the lines of "if you are trying to do X, you will have issues of the form A and B". As an experienced programmer I regard advice of that form from other programmers knowledgeable in the problem domain as gold. Finally the book is well written and an easy read. The book is not meant to be a comprehensive reference, which I mention not as a drawback but in case someone is expecting that. I plan to recommend it to all of the programmers and development managers who come to my company from college or another industry.

Getting to Meaningful Use and Beyond Is a book about the meaningful use standards for electronic health records in the united states. I grabbed a preview copy of this book having implemented a simple database for a patient record reporting for a small therapy group many moons ago. I was expecting a dry boring book, but was pleasantly surprised to find it engaging and well written.

Health IT systems provide great promise for improving the efficiency and quality of health services, with the cautious guard that IT implementations for large organizations carry huge risk of failure. Queensland Health have been an example of what can go wrong, particularly with their spectacular payroll system failures after a recent upgrade.

Getting to Meaningful Use and Beyond presents many of the opportunities with health IT, informing of some of the great successes, while informing of the risks and challenges.

A quote in the book says "When you've seen one medical practice, you've seen one medical practice." which forms a basis for one of the key challenges in Health IT systems. The book continues the point out some of the differences, and considerations to include. It highlights the requirements and value for helping to follow the processes for health it systems, but also the need for flexibility and customization. It cries out for techniques like those used by FlexaData http://flexadata.com/ for modeling and working with data.

I was reviewing an early access version of the book, which was well worth reading on it's own right, even with some typos and a couple of chapters missing. It will be interesting to see how the book evolves with a changing landscape. In particular I look forward to seeing the authors comments on the pending demise of Google Health (google health was referenced in the book, but the comments predate knowledge of it's pending close in 2012).

I'd definitely recommend the book to anyone considering HealthIT, or an IT professional interested in health. There is also some great pointers and ideas useful for computer literate people who are dealing with health issues.

[This book was reviewed as a part of the O'Reilly Blogger Review Program]